Form QI 1 QI 1 Quality Toolkit Survey

OMB No.

Exp. Date:

HRSA Quality Toolkit Survey

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is ___________. Public reporting burden for this collection of information is estimated to average 4 minutes per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-33, Rockville, MD 20857

1. How did you first learn about the HRSA Quality Toolkit?

From a work colleague

From an e-mail, listserv or website

At a meeting or conference

From the radio, newspaper or magazine

Other

2. Which of the following best describes you?

Clinician including doctors, dentists, advanced practice nurses, or physician assistants

QI director or administrator

Nursing including RN or LPN

Allied Healthcare Professionals, including nutritionists, social workers, dietitians, behavioral specialists, and other health care professionals

Pharmacists

Other

3. How helpful was the information you found in the Quality toolkit module you reviewed?

(5=maximum knowledge and awareness, 1=no knowledge or awareness gained)

5

4

3

2

1

4. How easy was it for you to find information in the module you reviewed

Easy

Somewhat easy

Difficult

5. Please complete this sentence:

Using the HRSA Quality Toolkit I wish I could

6. Please rate the tools and resources found within the module you reviewed:

(5=very useful, 1=not useful)

5

4

3

2

1

7. Please rate your level of agreement with the following statements

	Strongly agree	Disagree	Neither disagree nor agree	Agree	Strongly agree	Not applicable
It was easy to find what I was looking for.
It was easy to navigate through the site.
The information I found was up-to-date
The information I found was reliable
The tools and resources I found are useful
I will be able to apply information and tools in my organization